00 SPONSOR SUBSTITUTE FOR SENATE BILL NO. 68 01 "An Act relating to the practice of dental hygiene; establishing an advanced practice 02 permit; prohibiting unfair discrimination under group health insurance against a dental 03 hygienist who holds an advanced practice permit; and relating to medical assistance for 04 dental hygiene services." 05 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA: 06  * Section 1. AS 08.32.110(e) is amended to read: 07 (e) This section does not prohibit a licensed dental hygienist 08 (1) with an endorsement issued under AS 08.32.085 from performing 09 the activities authorized under AS 08.32.085; 10 (2) who holds an advanced practice permit issued by the board  11 under AS 08.32.125 or has entered into a collaborative agreement approved by the 12 board under AS 08.32.115 from performing the activities authorized under the permit  13 or collaborative agreement; or 14 (3) from performing a dental operation, procedure, or service a dentist 01 may delegate to a dental assistant under AS 08.36.346. 02  * Sec. 2. AS 08.32 is amended by adding a new section to read: 03 Sec. 08.32.125. Advanced practice permits. (a) The board may issue an 04 advanced practice permit to a licensed dental hygienist with a minimum of 4,000 05 documented hours of clinical experience. A licensed dental hygienist holding an 06 advanced practice permit may perform one or more of the following: 07 (1) oral health promotion, disease prevention education, and oral 08 systemic health education; 09 (2) removal of calcareous deposits, accretions, and stains from the 10 surfaces of teeth; 11 (3) application of topical preventive or prophylactic agents, including 12 silver diamine fluoride, fluoride varnishes, and pit and fissure sealants; 13 (4) polishing and smoothing restorations; 14 (5) removal of marginal overhangs; 15 (6) preliminary charting and triage to formulate a dental hygiene 16 assessment and dental hygiene treatment plan; 17 (7) the exposure and development of radiographs; 18 (8) use of local periodontal therapeutic agents; 19 (9) nonsurgical periodontal therapy, with or without the administration 20 of local anesthesia; 21 (10) screening for oral cancer; 22 (11) administration of local anesthesia; and 23 (12) writing prescriptions for 24 (A) fluoride that is applied or provided to a patient; and 25 (B) chlorhexidine or a similar antibacterial rinse. 26 (b) A licensed dental hygienist holding an advanced practice permit may 27 provide the services described in (a) of this section to a patient who is unable to 28 receive dental treatment because of age, infirmity, or disability and is 29 (1) a resident in a senior center, including a hospital, long-term care 30 facility, adult foster home, residential care facility, or adult congregate living facility; 31 (2) a resident in a health care facility, including a mental health 01 residential program or facility for individuals with developmental or other disabilities; 02 (3) held in a local correctional facility for juveniles or adults; 03 (4) enrolled in a nursery school, day care program, vocational training 04 facility, primary school, secondary school, private school, or public charter school; 05 (5) entitled to benefits under 42 U.S.C. 1786 (Special Supplemental 06 Food Program for Women, Infants, and Children); 07 (6) homebound; or 08 (7) a resident of a dental health professional shortage area designated 09 under 42 U.S.C. 254e. 10 (c) A licensed dental hygienist holding an advanced practice permit may 11 provide the services described in (a) of this section to a patient described in (b) of this 12 section without 13 (1) the physical presence, authorization, or supervision of a licensed 14 dentist; 15 (2) a licensed dentist's examination of the patient. 16 (d) A licensed dental hygienist who provides services under an advanced  17 practice permit shall maintain professional liability insurance and provide the patient, 18 or the parent or legal guardian of the patient, with 19 (1) a written notice that the treatment provided will be limited to 20 services permitted under (a) of this section; 21 (2) a written recommendation that the patient be examined by a 22 licensed dentist for comprehensive oral health care services; and 23 (3) assistance in obtaining a referral to a licensed dentist for further 24 dental planning and treatment, including a written description of methods for 25 obtaining a referral and a list of licensed dentists in the patient's community or other 26 resources for finding a licensed dentist. 27 (e) A licensed dental hygienist holding an advanced practice permit may 28 practice as an independent contractor. 29 (f) An advanced practice permit is valid until the expiration of the dental 30 hygienist's license to practice. A licensed dental hygienist may renew an advanced 31 practice permit at the time of license renewal under AS 08.32.071.  01  * Sec. 3. AS 21.36.090(d) is amended to read: 02 (d) Except to the extent necessary to comply with AS 21.42.365 and 03 AS 21.56, a person may not practice or permit unfair discrimination against a person 04 who provides a service covered under a group health insurance policy that extends 05 coverage on an expense incurred basis, or under a group service or indemnity type 06 contract issued by a health maintenance organization or a nonprofit corporation, if the 07 service is within the scope of the provider's occupational license. In this subsection, 08 "provider" means a state licensed physician, physician assistant, dentist, osteopath, 09 optometrist, chiropractor, advanced practice registered nurse, naturopath, physical 10 therapist, occupational therapist, marital and family therapist, psychologist, 11 psychological associate, licensed clinical social worker, licensed professional 12 counselor, [OR] certified direct-entry midwife, or dental hygienist holding an  13 advanced practice permit. 14  * Sec. 4. AS 47.07.030(b) is amended to read: 15 (b) In addition to the mandatory services specified in (a) of this section and the 16 services provided under (d) of this section, the department may offer only the 17 following optional services: case management services for traumatic or acquired brain 18 injury; case management and nutrition services for pregnant women; personal care 19 services in a recipient's home; emergency hospital services; long-term care 20 noninstitutional services; medical supplies and equipment; advanced practice 21 registered nurse services; clinic services; rehabilitative services for children eligible 22 for services under AS 47.07.063, substance abusers, and emotionally disturbed or 23 chronically mentally ill adults; targeted case management services; inpatient 24 psychiatric facility services for individuals 65 years of age or older and individuals 25 under 21 years of age; psychologists' services; clinical social workers' services; marital 26 and family therapy services; midwife services; prescribed drugs; physical therapy; 27 occupational therapy; chiropractic services; low-dose mammography screening, as 28 defined in AS 21.42.375(e); hospice care; treatment of speech, hearing, and language 29 disorders; adult dental and dental hygiene services; prosthetic devices and 30 eyeglasses; optometrists' services; intermediate care facility services, including 31 intermediate care facility services for persons with intellectual and developmental 01 disabilities; skilled nursing facility services for individuals under 21 years of age; and 02 reasonable transportation to and from the point of medical care.